Patient guidance

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Colonoscopy and bowel cleansing instructions Visual examination of the colon

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A colonoscopy is a visual examination of the rectum and colon with a view to determining the presence of abnormalities in these regions.

ColonoscopeA colonoscope is a flexible tube about the size of a finger. It is fitted with a camera and connected to a TV screen. The specialist can guide the colonoscope through the rectum and colon with a view to determining the presence of abnormalities in the mucous membranes.

Using a small pincers inserted through the colonoscope, the specialist can take samples from the mucous membrane. This is painless. If the specialist finds polyps in the colon, these can also be removed via the colonoscope.

When is a colonoscopy performed?A colonoscopy should be performed if:

• You have intestinal bleeding• You have had abnormal stools for

more than 4 weeks• You have unexplained gastro-

intestinal symptoms• A microscopic examination has

indicated that there is blood in your stools

• If an X-ray examination suggests that you may have colorectal polyps

• If you have previously had colorectal polyps removed

• If you have previously suffered from colorectal cancer

Finally, a colonoscopy is often performed in connection with screening for colorectal cancer.

Preliminary examination A colonoscopy is an out-patient examination, performed with or without a preliminary examination.

A colonoscopy can be performed:

• without painkillers • under the influence of sedative and

analgesic medication, or • under general anaesthetic

If the colonoscopy is performed under general anaesthetic, you will always be invited to attend a preliminary examination first.

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Colon

Rectum

Lower part of the small intestine

Proliferation of colorectal cancer

Colorectal cancers usually develop from a benign adenoma (or polyp), which is a precursor of cancer (stage 0). Stage 1 is an early stage of cancer. Without treatment, the cancer will spread until it reaches stage 4, where it will have spread to lymph nodes and/or other organs, such as the liver and lungs.

Lymph node

Spreading to other organs

Colonoscope

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PreparationMedicineIf you are taking anticoagulants, such as Marevan, Marcoumar, Plavix® or Persantin® , please contact us immediately for advice. This also applies if you are taking diabetic medication.

Please bring a list of the medicines you take, including herbal remedies (if any).

You may not take iron supplements for 1 week before the examination.

You may continue to take any other prescribed medication as usual.

Bowel cleansingThe rectum must be emptied completely and you must fast before the examination. See bowel cleaning instructions on pages 8-9 or 10-11.

Due to very frequent visits to the toilet, you should not count on being able to work when you start taking PicoPrep® to cleanse your bowels.

The examinationThe examination takes 15-60 minutes, depending on whether the specialist takes tissue samples or removes polyps.

You will lie on your left side during the examination.

The colonoscope is inserted into the rectum and up into the colon. The full length of the colon will be examined. If the specialist suspects that the presence of a disorder in the lower part of the small intestine, the lowest 10-15 cm of the small intestine will also be examined.

Is it painful?The examination may be unpleasant. Some patients may briefly have some abdominal pain but this is not usually more severe than most patients can tolerate.

A puff of air is pumped into the colon to ensure that the folds are open and that the specialist can examine the colon walls systematically. You may find this causes discomfort and bloating. The specialist will release some of the air at the end of the examination and the discomfort will dissipate.

SedativeIn rare cases, in order to perform the examination, it may be necessary to administer a sedative.

General anasthesiaIn some cases it may be AGREED TO IN ADVANCE that you sleep through the examination (general anesthesia).

You must always follow the cleansing-program in this folder (please see the back of the folder).

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After the examinationThe examination is an out-patient procedure and the patient will usually return home immediately after it.

However, if you have been given a sedative, or if the specialist has taken tissue samples or removed polyps, you will be asked to remain under observation at the hospital for about 30 minutes. If the examination was performed under general anaesthetic, you should expect to remain at the hospital for about 1 hour after the examination, until you are fully recovered.

If you have been given a sedative or anaesthetic, you must make sure that you have someone (an adult) to accompany you on your journey home. You may not drive a car, ride a motorcycle, moped or bike for the rest of the day. Neither should you operate any dangerous tools for the rest of the day.

Food and drinkYou may eat and drink normally before the examination.

Examination resultsThe specialist will talk to you about the results before you leave the hospital.

You will later receive a description of the examination in the mail.

If a biopsy was taken, the results will be available within 8-14 days. Before you leave the hospital, you and the specialist decide how you will receive the results of the biopsy and whether further appointments are necessary.

Potential side-effects and complicationsA colonoscopy is a very safe examination, which very rarely causes complications.

If treatment is made during the colonoscopy, for example, if polyps are removed, in rare cases complications can occur in the first week after the treatment.

Possible complications are:

• Severe abdominal pain• Bloody or black stools• Discomfort, nausea or sweatiness• Temperature above 38°C• Shivering

You should contact Aleris-Hamlet if you observe any of these symptoms. In extremely rare cases (less than 1 per thousand examinations), compli-cations may be caused by a puncture in the colon wall, which may require surgery.

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Patient satisfactionTo ensure that Aleris-Hamlet continues to provide the best care, treatment and service, please complete our patient satisfaction questionnaire, which you will receive in the mail (if you have given us permission to send one). Comments and criticism, whether positive or negative, are important to us as they ensure that we can continue to offer the best possible treatments for our patients.

There are stands in every unit, where we ask if you would recommend Aleris-Hamlet to others. To respond, touch the smiley you think is most appropriate.

Any complaints about your progress at Aleris-Hamlet we ask that you please forward directly to Aleris-Hamlet Directors , att. Medical officer, Aleris-Hamlet Gyngemose Parkvej 66, 2860 Søborg.

If you do not wish to complain to us directly, you have access to lodge a complaint via Patientombuddet’s (the National Agency for Patients’ Rights and Complaints’) website: www.patientombuddet.dk. The web site provides guidance and a complaints form (in Danish).

If you believe that a medical error has been made and you wish to claim compensation, you should contact Patientforsikringen (the Patient Insurance Association). Visit www.patientforsikringen.dk. The website provides guidance and a complaint form (in Danish and English).

Instructions for your examinationYou must follow the instructions that match the time of your examination.

• 8 AM - 3 PM, go to page 8• 3 PM - 8 PM, go to page 10

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Bowel cleansing instructions prior to colonoscopy

Bowel cleansing and instructions in relation to food and drink.

To ensure the successful performance and results of the examination, it is imperative that the bowel is emptied completely before the examination. Thorough bowel cleansing is there-fore required.

• In the week before the examination, you may not eat anything containing seeds.

• 3 days before the examination, take 2 x Toilax laxative tablets at 8 pm.

• 2 days before the examination, take 2 x Toilax laxative tablets at 8 pm.

Frequent visits to the toiletYou are advised that the cleansing procedure will cause frequent visits to the toilet and that your stools will be very thin and watery. Many visits to the toilet during the bowel cleansing procedure can irritate the rectal opening. To soothe irritation, apply zinc cream.

You may take medicine as usual throughout the bowel cleansing period. If you take diabetic medication , please contact Aleris-Hamlet before you begin the bowel cleansing programme.

If you have questions, you are of course welcome to contact us at any time.

Purchase the following from your local pharmacy: Toilax 5 mg laxative tablets and 2 x sachets of PicoPrep®

(available over the counter).

PicoPrep® contains lactulose. If you can not tolerate lactose or if the

pharmacy does not sell PicoPrep®, please ask the pharmacist

to recommend a similar cleansing product.

Examination 8 am - 3 pm

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Examination 8 am - 3 pmThe day before the examination

Time Action

Between 7 and 8 am

You may eat a light breakfast, for example, a slice of white bread with a soft-boiled egg. You may only ingest a liquid diet for the rest of the day (see figure 1)

Between 8 am and 3 pm

Drink at least 1½ litres of fluid

At 3 - 3.30 pm Drink 1 sachet of PicoPrep® dissolved in a large glass of water. Stir well (for 2-3 min). If the mixture is too warm, add ice cubes. Then drink a further ½ litre of liquid.

Between 3.30 pm and 7 pm

Drink at least 1 litre of fluid.

At 7 pm Drink 1 sachet of PicoPrep® dissolved in a large glass of water. Stir well (for 2-3 min). If the mixture is too warm, add ice cubes. Then drink a further ½ litre of liquid.

After 7 pm and until bedtime

Drink at least 1 litre of fluid.

Figure 1 Liquid

• Water• Cordial• Fizzy drinks• Clear broth• Juice without fruit pulp• Coffee and tea• You may not ingest dairy products

You should try to drink fluids containing salt (broth) and sugar (cordial and juice) during the day

On the day of the examination, you may ingest a liquid until 2 hours before the examination .

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Bowel cleansing instructions prior to colonoscopy

Bowel cleansing and instructions in relation to food and drink.

To ensure the successful performance and results of the examination, it is imperative that the bowel is emptied completely before the examination. Thorough bowel cleansing is there-fore required.

• In the week before the examination, you may not eat anything containing seeds.

• 3 days before the examination, take 2 x Toilax laxative tablets at 8 pm.

• 2 days before the examination, take 2 x Toilax laxative tablets at 8 pm.

• The day before the examination, take 2 x Toilax laxative tablets at bedtime

Frequent visits to the toiletYou are advised that the cleansing procedure will cause frequent visits to the toilet and that your stools will be very thin and watery. Many visits to the toilet during the bowel cleansing procedure can irritate the rectal opening. To soothe irritation, apply zinc cream.

You may take medicine as usual throughout the bowel cleansing period. If you take diabetic medication , please contact Aleris-Hamlet before you begin the bowel cleansing programme.

If you have questions, you are of course welcome to contact us at any time.

Examination 3 pm - 8 pm

Purchase the following from your local pharmacy: Toilax 5 mg laxative tablets and 2 x sachets of PicoPrep®

(available over the counter).

PicoPrep® contains lactulose. If you can not tolerate lactose or if the

pharmacy does not sell PicoPrep®, please ask the pharmacist

to recommend a similar cleansing product.

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Examination 3 pm - 8 pmThe day before the examination

Time Action

Between 7 and 8 am

You may eat a light breakfast, for example, a slice of white bread with a soft-boiled egg, A38/plain yoghurt. You may only ingest a liquid diet for the rest of the day (see figure 1)

Between 8 am and 7 pm

Drink at least 1½ litres of fluid

At 7 pm Drink 1 sachet of PicoPrep® dissolved in a large glass of water. Stir well (for 2-3 min). If the mixture is too warm, add ice cubes. Then drink a further ½ litre of liquid.

After 7 pm and until bedtime

Drink at least 1 litre of fluid. At bedtime, take 2 Toilax tablets

On the day of the examination

Time Action

Before 8 am You may eat a light breakfast, for example, a small serving of A38/plain yoghurt . You may only ingest a liquid diet for the rest of the day (see figure 1)

At 8 - 8.30 am Drink 1 sachet of PicoPrep® dissolved in a large glass of water. Stir well (for 2-3 min) If the mixture is too warm, add ice cubes. Then drink a further ½ litre of liquid.

Figure 1 Liquid

• Water• Cordial• Fizzy drinks• Clear broth• Juice without fruit pulp• Coffee and tea

You should try to drink fluids containing salt (broth) and sugar (cordial and juice) during the day

On the day of the examination, you may ingest a liquid until 2 hours before the examination .

Aleris-Hamlet Hospitals ©

24th edition October 2018. Prepared by OLR/KJK/BMI.

To be revised in October 2021. Approved by Quality Management

KUJF 32

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Aleris-Hamlet Hospitaler - West

Aleris-Hamlet Hospitaler - East

www.aleris-hamlet.dk